HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA
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All APPLICABLFA -7eimE COMPLETED FOR APPLICATION TO BE ACCEP'i r-v" (�
Date: Permit Number: I A _0 M
nn s Permfttfng
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential
PERMIT APPLICATION FOR: sw/Ins /N 4 /Jo d /
Address:
Property Tax ID #:Sd
Site Plan Name:
Project Name: G/y�
__.. _.01
New Electrical Meter Second Electrical Meter
Lot No._
Block No.
I3'u ti? s - d$ 7?';4' ,w G wpa; r r rrt}a n: x s :c�a r rxs .x .€ k
:_CON�TRUCT�ON
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas, Piping _ Shutters
&-Electric `Prumbing- _Sprinklers _Generator
_ Windows/Doors — Pond
Total Sq. Ft of Construction:Q 4 940 Sq. Ft. of First Floor:
Cost of Construction: $
Roof Pitch
Utilities: —Sewer —Septic Building Height:
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,CONTAC,TOR } �,i
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Name /
Name: ROBERTS BRUHN
Address i 7Z A&Z
Company- LOUDEN POOLS
City: �" State �
Address:4306 S US 1
City: FORT PIERCE State: FL
Zip Code: Fax:
Phone No.
Zip Code: 34982 Fax: 772-465-1063
E-Mail:
Phone N0772-465-2700
Fill in fee simple Title Holder on next page (if different
E-Mail pwxlisa@yahoo.com
from the Owner listed above)
State or County License cpc1458612
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGN /EN E : _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name. d
Name:
Address: D/ Z�/tr I0J
Address:
City / L.t._ State:
City: State:
Zip: Phone 7A - -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:. _
Zip: T Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no .work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will'authorize the permit�holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions.which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and post e. jobsite before the first inspection. If you intend,to obtain financing, consult
with lender or an�ttorn v before imencinR work or recording your Notice of Commencement.
Signatu,perof Owner/ Lessee/Contractor as Agent for Owner
Signature 9KC&ntractoFlUrense Mlder
STATE OF FLORID /
Zel
STATE OF FLORIDAO
COUNTY OF 7g'-
COUNTY OF
5 orn to (or affirmed) and subscribed before me of
Sw r to (or affirmed) and subscribed before me of
Physical PresenA or Online Notarization
Y Physical Preseqp or Online Notarization
this ,7-7 day of 2020 by
this ,Z:� day of 2020 by
ROBERT S BRUHN
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known x OR Produced Identification
T of Id t' ication
-Type en ' ica ion
rodu
Y
Pro ce
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(r nature of Notary ublic- a Qof da SHERRI FEHL
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( at re of Not Pub c-Stage - rotida LN1A�V
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Commission # GG 1 160
Commission No. N•t oQ(SeaIm) mes March 14, 2022
v ommission # GG 187160
Commission No. 'lFo `Pg.' (Seres R1arch 14, 2022
Bonded TTw Budget Notary Services
' audget Notary Serves
.REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE '
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/20
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